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Mask Ventilation
Question 1 Complications of oral or nasal airway placement include which of the following? a.Bleeding b.Trauma to the tongue c.Airway obstruction d.Nasal turbinate dislocation e.All of the above Answered e. All of the above ________________________________________ Question 2 The anesthesiologist is called to the emergency room to manage the airway of a 78-year-old man who has suffered a myocardial infarction at a local restaurant and is unconscious. He is approximately 178 cm tall and weighs about 104 kg. He has a large face, full beard, and upper and lower dentures. A respiratory therapist is at the head of the bed attempting manual positive pressure ventilation by mask. There is no chest rise despite a measured positive pressure of 50 cm H2O. An intubation kit has been called for. Arterial oxygen saturation is 85%. Which of the following patient characteristics increases the difficulty of mask ventilation? a.Age b.Presence of dentures c.Beard d.Mallampati Class II e.Pulmonary edema Answered: c. Beard ________________________________________ Question 3 The anesthesiologist is called to the emergency room to manage the airway of a 78-year-old man who has suffered a myocardial infarction at a local restaurant and is unconscious. He is approximately 178 cm tall and weighs about 104 kg. He has a large face, full beard, and upper and lower dentures. A respiratory therapist is at the head of the bed attempting manual positive pressure ventilation by mask. There is no chest rise despite a measured positive pressure of 50 cm H2O. An intubation kit has been called for. Arterial oxygen saturation is 85%. With a good jaw thrust, there is a small chest rise, but ventilation requires two hands on the mask and a second person providing positive pressure. Arterial oxygen saturation stabilizes at 88% and does not fall farther. The anesthesiologist decides to place an "airway" to aid ventilation. Which of the following statements best describes the use of additional airways to assist with mask ventilation? a.An oral airway should be of a size such that when it is placed with the flange next to the corner of the mouth, the curved part of the airway touches the earlobe. b.An oral airway should be of a size such that when placed with the flange next to the front teeth, the curved part of the airway touches the angle of the jaw. c.A nasal airway should be of a size such that when it is placed with the flange next to the nostril, the airway should reach the angle of the jaw. d.After insertion of an oral airway, if airway obstruction is still present, then the airway is too short. e.During insertion of a nasal airway, it is common to encounter high resistance at the level of the nasal turbinates-increased pressure should be applied to maneuver the airway past the obstruction Answered: a. An oral airway should be of a size such that when it is placed with the flange next to the corner of the mouth, the curved part of the airway touches the earlobe. 詳解 (1)An appropriate sized oral airway is one that, when placed with the flange next to the corner of the mouth, touches the earlobe with the curved part of the airway. (2)An appropriate sized nasal airway is one that, when the flange is placed next to the front teeth, reaches the angle of the jaw. ________________________________________ Question 4 The anesthesiologist is called to the emergency room to manage the airway of a 78-year-old man who has suffered a myocardial infarction at a local restaurant and is unconscious. He is approximately 178 cm tall and weighs about 104 kg. He has a large face, full beard, and upper and lower dentures. A respiratory therapist is at the head of the bed attempting manual positive pressure ventilation by mask. There is no chest rise despite a measured positive pressure of 50 cm H2O. An intubation kit has been called for. Arterial oxygen saturation is 85%. A nasal airway is placed, and after about 5 minutes of difficult, two-handed mask ventilation, an intubation kit arrives. The patient is intubated without further incident. He awakens the next morning and is extubated with normal arterial oxygen saturation. A complication of mask ventilation has occurred. Which of the following is the most likely complication? a.A pneumothorax. b.Aspiration pneumonitis. c.Jaw dislocation. d.Nasal turbinate dislocation. e.Chin numbness. Answered: e. Chin numbness. ________________________________________ Question 5 The anesthesiologist is called to the emergency room to manage the airway of a 78-year-old man who has suffered a myocardial infarction at a local restaurant and is unconscious. He is approximately 178 cm tall and weighs about 104 kg. He has a large face, full beard, and upper and lower dentures. A respiratory therapist is at the head of the bed attempting manual positive pressure ventilation by mask. There is no chest rise despite a measured positive pressure of 50 cm H2O. An intubation kit has been called for. Arterial oxygen saturation is 85%. The patient's neck is slightly flexed, and the respiratory therapist has his fingers wrapped under the chin in the submental space. What is the next best maneuver? a.Ask the respiratory therapist to use two hands to apply the mask, and take over pressing the bag, increasing the pressure until ventilation is achieved. b.Assess the airway, place the head in sniffing position, and apply pressure at the angle of the jaw to "thrust" it forward. c.Remove the dentures and attempt mask ventilation. d.Place a nasal airway. e.Place an oral airway. Answered: b. Assess the airway, place the head in sniffing position, and apply pressure at the angle of the jaw to "thrust" it forward. ________________________________________ Question 6 Patient predictors of difficult mask ventilation include all of the following EXCEPT a.Body mass index >30 kg/m2 b.Inability to protrude the mandible c.Presence of a beard d.Limited oral opening e.History of sleep apnea Answered: d. Limited oral opening ________________________________________ Question 7 During single-handed mask ventilation, a circuit pressure of 30 cm H2O is required to achieve chest rise. The patient is obese. You should: a.Not worry about it. It takes more pressure to ventilate an obese patient. b.Stop, reposition the head, and try again, observing inspiratory pressure requirements. c.Consider placing an oral airway. d.Consider placing a nasal airway. e.B, C, and D Answered: e. B, C, and D